|March 16, 2005|
Volume 7, Issue 6
|Midwifery Today E-News|
“Herbs for Labor”
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Did you know that shiatsu can be used to alleviate many of the chronic symptoms of pregnancy such as backache and morning sickness? It can also be helpful during labor and birth and can relieve postnatal problems. Based on traditional Chinese and Japanese health approaches, shiatsu encourages the body to balance its own natural energy by gentle stimulation of its energy pathways. Shiatsu for Midwives shows you how to take the core midwifery skills of touch, gentle pressure and massage and use them in a more systematic and focused way.
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In This Week’s Issue:
Quote of the Week
"The midwife considers the miracle of childbirth as normal, and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble: if he leaves it alone, it's a miracle."
— Sheila Stubbs
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The Art of Midwifery
I found that when a woman has back labor, sitting on the toilet backward works wonders, especially in late first stage. You might ask yourself, What is the difference between sitting backward or forward? Try it yourself - you will feel the difference in your physical attitude (position). Keep your feet flat on the floor, feel what it does to your back. But remember, some things work for some people and some things work for others. Have many tools at your disposal, and remember, good support is worth a hundred milligrams of Demerol.
— Linda Thorpe, nurse-midwife
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Research to Remember
A study of 160 women, average age 32, receiving in vitro fertilization (IVF) revealed that acupuncture before and after the embryo transfers helped increase the number of pregnancies. Eighty of the study participants received acupuncture 25 minutes before and after the transfer, and 80 women in the control group did not. The needles were placed in stomach, colon and ear meridians to increase blood flow and energy to the uterus, provide a sedative effect and stabilize the endocrine system. In the treated group, 34 women (42.5%) became pregnant, while in the untreated group, 21 (26.3%) became pregnant. All the women in the study group had undergone an average of two previous IVF cycles.
— Fertility and Sterility, April 2002; 77(4): 721–4.
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Herbs for Labor
Black Cohosh (Cimicifuga racemosa)
Black cohosh and blue cohosh are often considered the best combination to have on hand for labor. Black cohosh is not only excellent as a liniment for back labor, it is also used to relieve pain and cramping in the womb. It relieves muscle pain, which is one reason it works so well with blue cohosh, the uterine stimulant.
In more than 40 years of observed use in Germany, black cohosh has shown no serious adverse effects, contraindications or drug interactions. One study did show that 7% of patients who took it experienced transient stomach upset, but not to an extent to prevent the trial from continuing. Studies on the herb's possible mutagenicity, teratogenicity and carcinogenicity have proven negative.
Relevant properties: anti-spasmodic, alterative, nervine, hypotensive. It is high in volatile oils and contains triterpene glycosides, isoflavones and isoferulic acid.
Blue Cohosh (Caulophylum thalictroides)
Blue cohosh can be used at any time during pregnancy that a threat of miscarriage occurs. Similarly, because of its anti-spasmodic action, it will ease false labor pains and dysmenorrhea. Nonetheless, when labor does begin, using blue cohosh just previous to birth will ease delivery. Blue cohosh stimulates uterine contractions and tones the uterus.
Relevant properties: emmenagogic, anti-spasmodic, anti-rheumatic, diuretic. It contains alkaloids and saponins.
Shepherd's Purse (Capsella bursa-pastoris)
Shepherd's purse has long been a number one recommendation for hemorrhage and excessive bleeding. It is a styptic herb that constricts blood vessels and tissue, lowers blood pressure and contracts the uterus. Shepherd's purse leaves provide vitamins C and K, some protein, sulfur, calcium, iron and sodium. In the United States it has been used following expulsion of the placenta since the time of the Pilgrims.
Relevant properties: astringent, anti-inflammatory, diuretic, hemostatic. It contains flavonoids, polypeptides and plant acids.
Motherwort (Leonurus cardiaca)
Though motherwort is not to be used until labor, it can ease early labor pains if they begin prematurely. It can also alleviate the restlessness, anxiety, tension and insomnia some women experience during labor. After childbirth it is given to help the uterus relax and return to normal.
Relevant properties: nervine, emmenagogic, anti-spasmodic, hepatic. It is a cardiac tonic and contains iridoids, diterpenes and flavonoids.
Trillium (Trillium erectum)
Trillium is used prior to labor to smooth the progress of contractions and ensure an easier delivery. It also can decrease the incidence and severity of postpartum hemorrhage.
Valerian (Valeriana officinalis)
Valerian is wonderful as an internal or topical pain reliever. It also can induce relaxation and sleep. Valerian has been found to slow preterm labor. This does not mean it will stop a preterm delivery. Valerian can be used to massage sore thighs and backs.
Cranesbill (Geranium maculatum)
Cranesbill has astringent properties and has long been used to prevent or stop hemorrhage in childbirth. It is also anti-inflammatory and can be used topically on sore tissues or hemorrhoids.
— Demetria Clark, "What Herbs Are Good for Labor?" in The Birthkit Issue 43
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Web Site Update
The complete program, registration page and travel information for the Midwifery Today conference in Nassau, Bahamas 22–26 September 2005 are now online. Caribbean midwives join some of the most sought-after teachers in the birth field, including Marina Alzugaray, Michel Odent, Robbie Davis-Floyd, Marsden Wagner, Mabel Dzata and Naolí Vinaver.
Read this editorial from the brand-new issue of Midwifery Today, Issue 73, now online:
At a Midwifery Today conference a few years ago, we were shown Mexican techniques for getting the mom's bones set back in place and other techniques such as correcting prolapsed uterus and bladder. I'd like to know—what do you do for moms postpartum besides check on them? Do you do massage, baths, anything
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Question of the Week
Q: I was blessed with a wonderful homebirth under the watchful eyes and in the warm hands of two local midwives in the state of Illinois. This was my fourth homebirth and sixth pregnancy. The birth of my eight-pound, four-ounce baby went beautifully. It was not until I got out of the birthing pool and onto the birthing stool to release our placenta that my uterus prolapsed. My midwives did their best and gave me all the information they knew about uterine prolapse. I am reaching out to the bigger midwife community for additional advice about how to treat a prolapsed uterus and maintain uterine health through the rest of my life. I am only 24, and who knows what is in the future. If we choose to have another baby, what will likely happen? Your support, knowledge, and resources would be greatly appreciated.
SEND YOUR RESPONSE to email@example.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
Question of the Week Responses
Q: Are there any sources of information regarding the relationship between the throat and perineum during birth—when the throat is tight, the vaginal floor will also be tight?
— Giselle E. Whitwell, doula, board-certified music therapist, Birth Works childbirth educator, certified prenatal parenting educator
A: I don't know of any hard research on the subject, but the best proof I've seen for a connection between a tight throat and a tight perineum is this: Open your throat and make a low moaning sound. Become aware of your perineal area. Then make a high pitched shrieking sound. Everything slams shut! This works for men, too.
— Winnie Sunshine, RN
Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
I read Mary Jo's suggestion about bringing the soles of the feet together and wrapping them with a towel that the mother can grasp to draw toward her [Issue 7:4]. I duly copied it and filed it, never imagining I would be using it within the next 24 hours. I would like to thank Mary Jo for giving us one more opportunity to "try everything" before moving to the OR for a cesarean.
The woman I was accompanying in labor arrived at our birth center with a well-established labor. She labored for an additional nine hours before her first vaginal check. We were very surprised by the long, thick, posterior cervix with no dilation. Easy for someone not there to claim that she wasn't in labor (it crossed your mind didn't it?), but this was a steady pattern of increasingly longer contractions and shorter intervals. The mom requested a check because she just wanted to use the tub around second stage and not hang out in the water. We thought we were confirming that it *was* time, so this was a surprise for us too.
While we are very aware of the limits of x-ray for "diagnosis," we also believe in honoring the baby's wisdom and thought perhaps this baby knew something we didn't. In addition to using the squatting position for the x-ray, I asked the mom if she would be willing to try Mary Jo's positional recommendation. She was. The resulting x-ray showed a disproportion that was difficult to deny.
We (parents, doula, OB and radiologist) were fascinated by the perspective that this position, in combination with the x-ray picture, offered. The x-ray revealed that the mother had *no* ischial spines but narrow side walls of the cavity and a previously broken sacrum (which the mother had never mentioned). The baby was 3.700 or about 8 lb 3 oz, which certainly didn't explain the disproportion. The x-ray pictures helped ease everyone's feelings about the unexpected trip to the OR. I am quick to agree that the mother doesn't grow a baby that her body doesn't know how to birth, but once in a while the body does suffer trauma that changes its capabilities.
Her baby was placed immediately on her mother's chest and was moved to her room with her. They have roomed-in and slept-in since.
P.S.: The doctor asked for the name of the woman who recommended this position. The x-ray was then labeled "Mary Jo"!
The medical rationalization for elective cesarean section is a pathological fear of labor and delivery. It has been documented that there are women for whom labor and delivery causes a hysterical reaction. Elective cesarean section is offered as a solution.
The pathological fear of hospitals, however, has yet to be recognized and defined as a disease state. Most midwives will at one time or another encounter women who arrive at the hospital in active labor, and yet the contractions stop almost immediately after arrival. An organized solution for these women has not been recognized or offered, nor has their condition even been recognized by the establishment. For those women, a rational solution would be a safe planned homebirth with experienced practitioners.
Hopefully researchers will soon document the frequency of pathologic fear of hospitals and formally suggest solutions for these women, just as doctors have suggested solutions for a pathological fear of birth.
— Judy Slome Cohain, CNM, MSN
Regardless of the official government stance on HIV, the fact is that HIV never made anyone seriously ill, no one ever died of HIV who wasn't also taking antiretroviral drugs, and that thousands of people have died of AIDS who never had HIV. There is no proof that HIV causes, or leads to, AIDS. Africans who purportedly have HIV also have all the symptoms of the age-old African problems stemming from poverty: malnutrition and non-potable water. The fact is that the NIH/CDC, politicians and pharmaceutical companies have entered into a pact to feather their nests at the expense of taxpayers. If people happen to die from allowing themselves to be misinformed, well, caveat emptor. Read anything by Peter Duesburg; start with "Inventing the AIDS Virus" (1996, Regnery Press); read the other books, articles, etc. listed on www.virusmyth.org. Read Christine Maggiore's "What if Everything You Thought You Knew about AIDS Was Wrong"; visit her Web site. No one, alas, has prohibited public health departments from promulgating lies. Yes, this probably puts clinicians such as CNMs, who have to follow their standard of care/protocols, in an awkward spot; they have my sympathy.
— Jill Herendeen, ICBE
A maternity T-shirt that has been available at Target stores nationwide carries the message, "An Epidural Is in My Future." I am president of the birth network Birth Alliance of Central California. We sincerely support every woman's choice in childbirth; however, we cannot support the advertisement of a medical procedure without informing consumers of its risks.
We're concerned about how advertising a serious medical intervention (one that comes with medical side effects, affects birth outcomes and can be an obstacle to the initiation of breastfeeding) as a benign occurrence in maternity care, without stating that choosing this intervention requires deep thought and informed choice, demonstrates a complete disregard and lack of responsibility to the consumer.
I am asking local networks and organizations that birth advocates/professionals and childbearing families look to for information, guidance and support to take a stand against such blatant consumer irresponsibility.
— Melanie Miner
I am a college student very interested in becoming a midwife, but I don't know where to get started. What information or tips can you share about how I can become involved in midwifery programs?
— Shayla, Birmingham, Alabama
A writer asked if it was safe to use a thyme and tea tree oil douche during pregnancy for yeast infections. Both are deeply penetrating oils, so though there may not be harm from them, they will penetrate through to the baby. Therefore, I do not recommend them in pregnancy unless there is no other way. After pregnancy, definitely use them. During pregnancy I recommend the following: no sugars, even honey; acidophilus (be sure it is refrigerated and the label says "viable or live culture"—not just at the time of manufacture) triple dose for at least three days, then normal dose; garlic, triple dose for three days, then normal dose. If that is not enough to get completely rid of the yeast infection (no leukocytes in a non-clean catch urine sample), then we recommend an acidophilus vaginal insert at bedtime for several days. Be sure it is not an enteric-coated capsule. If that is not enough, I recommend a douche with Tannalbit (zinc tannate) three times the first day and one time the second morning. This is usually enough to take care of almost all yeast infections. The key is *no sugar*! Getting rid of a yeast infection during pregnancy is much better than having a baby with thrush and ending up with a yeast breast infection after birth.
— Judy, CPM
I also found there to be truth in Gloria's comment about young women today being "overly dramatic" [Issue 7:2]. Of the small percentage of women in the United States today who actually even pursue a natural birth, it is my experience that a certain number, despite all efforts of childbirth preparation, will feel deceived that there is generally pain and work involved. In very early labor they become desperate for an epidural, although during pregnancy they claimed to believe wholeheartedly in nature or God's design. When did "natural" come to mean "no work?" When did pain become entirely useless and to be avoided at all costs? When did everyday conversation become a competition for who has the most terrible story to tell?
In the United States in the 1970s it was not the media that brought about the very counterculture return to natural birth and homebirth. Individuals brought about this dramatic change in birth culture and, subsequently, in medical practice (though we've since back-tracked)—individuals who, in stark contrast to the broader US culture at the time, deeply believed that birth works. In other words, the change was a "consumer-driven" change. What is different now?
The issue is very complex. It is undeniable that the amount of media imagery most people are exposed to has expanded dramatically since the "(mis)information age" dawned in the 1990s and that birth tends to be portrayed on TV as a disaster waiting to happen. Yes, the media have a powerful impact and can and do spread and reinforce fear. However, the media are a reflection of society. Look at what sort of television programs generally are most popular today (those that people choose to watch over others)—clearly we are a society addicted to drama. It's what sells. It's what people are buying.
Those of us in the birth field can get caught up in an endless "which came first, the chicken or the egg" debate about whether the problem in birth today originates with the individual (the micro) or with media and society (the macro), but the answer is really that our efforts are needed at every level. We need to keep writing those letters to broadcast companies, newspapers, etc., calling for accurate portrayals. We need to keep working on mother- and baby-friendly legislation. And we need to keep educating individual women to trust in birth and to take responsibility for themselves in their lives.
— Natalya Lukin, CPM
A young mother in Australia made an informed choice to have vaginal birth after caesarean (VBAC) after two prior caesareans rather than meekly submit to a third caesarean. The first hospital she attended reported her to Child Welfare for child abuse.
The birth was a tremendous success and beautifully supported by excellent staff in another hospital that she changed to very late in the pregnancy when she realised the first hospital had no intention of giving her a reasonable chance to at least try a VBAC. I was her birth support person, and although I have had two VBACs myself I was in absolute awe of this woman's determination and the beautiful safe way she chose to birth her baby.
I feel sorry for our "sisters" in the USA where a hospital can take women to court to force them to have a caesarean. However, I have not heard of that happening to VBAC mothers, although I did hear one story of a hospital threatening it. The woman ultimately chose a homebirth and had a successful VBAC. One American woman was charged for murder of one of her twins when it died at birth after she rejected medical advice for a caesarean. The woman was later found to be medically ill and the murder charge dropped.
The key issue to all of this is the woman's right to make her own informed choice and to be presented with correct evidence-based material to make that choice, regardless of whether that choice is a caesarean or a vaginal birth. Information vetting and bullying tactics are widely used by a number of medical practitioners to scare women into the birthing management the carer wants. I know there are some fantastic doctors and midwives out there who very much practice evidence-based medicine and respect their clients' wishes, but they seem to be the minority, not the majority.
— Deborah, Australia
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BABYNURSE: If you are looking for an experienced babynurse (also an RN), please give me a call or visit my Web site. Ask for Jean: (718) 778-2191. Web site: www.jaybeebabynurse.com
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